Section
II. STOP THE BLEEDING AND PROTECT THE WOUND2-15. Clothing (081-831-1016)In
evaluating the casualty for location, type, and size of the wound or injury, cut
or tear his clothing and carefully expose the entire area of the wound. This procedure
is necessary to avoid further contamination, Clothing stuck to the wound should
be left in place to avoid further injury. DO NOT touch the wound; keep it as clean
as possible.

WARNING
(081-831-1016)DO NOT REMOVE protective clothing in a chemical environment.
Apply dressings over the protective clothing.

2-16.
Entrance and Exit WoundsBefore applying the dressing, carefully examine
the casualty to determine if there is more than one wound. A missile may have
entered at one point and exited at another point. The EXIT wound is usually
LARGER than the entrance wound.

WARNINGCasualty
should be continually monitored for development of conditions which may require
the performance of necessary basic lifesaving measures, such as clearing the airway
and mouth-to-mouth resuscitation. All open (or penetrating) wounds should be checked
for a point of entry and exit and treatedaccordingly.

WARNINGIf
the missile lodges in the body (fails to exit), DO NOT attempt to remove it or
probe the wound. Apply a dressing. If there is an object extending from (impaled
in) the wound, DO NOT remove the object. Apply a dressing around the object and
use additional improvised bulky materials dressings (use thecleanest material
available) to build up the area around the object. Apply a supporting bandage
over the bulky materials to hold them in place.

2-17.
Field Dressing (081-831-1016)a. Use the casualty’s field
dressing; remove it from the wrapper and grasp the tails of the dressing with
both hands (Figure 2-28).

WARNINGDO
NOT touch the white (sterile) side of the dressing, and DO NOT allow the white
(sterile) side of the dressing to come in contact with any surface other than
the wound.

b.
Hold the dressing directly over the wound with the white side down. Pull the dressing
open (Figure 2-29) and place it directly over the wound (Figure 2-30).c.
Hold the dressing in place with one hand. Use the other hand to wrap one of
the tails around the injured part, covering about one-half of the dressing (Figure
2-31). Leave enough of the tail for a knot. If the casualty is able, he may assist
by holding the dressing in place. d.
Wrap the other tail in the opposite direction until the remainder of the dressing
is covered. The tails should seal the sides of the dressing to keep foreign material
from getting under it.e. Tie the tails into a nonslip knot over the
outer edge of the dressing (Figure 2-32). DO NOT TIE THE KNOT OVER THE WOUND.
In order to allow blood to flow to the rest of an injured limb, tie the dressing
firmly enough to prevent it from slipping but without causing a tourniquet-like
effect; that is, the skin beyond the injury becomes cool, blue, or numb.

2-18.
Manual Pressure (081-831-1016)a. If bleeding continues after
applying the sterile field dressing, direct manual pressure may be used to help
control bleeding. Apply such pressure by placing a hand on the dressing and exerting
firm pressure for 5 to 10 minutes (Figure 2-33). The casualty may be asked to
do this himself if he is conscious and can follow instructions.b.
Elevate an injured limb slightly above the level of the heart to reduce the bleeding
(Figure 2-34).

WARNINGDO
NOT elevate a suspected fractured limb unless it has been properly splinted. (To
splint a fracture before elevating, see task 081-831-1034, Splint a Suspected
Fracture.)

c.
If the bleeding stops, check and treat for shock. If the bleeding continues,
apply a pressure dressing.

2-19.
Pressure Dressing (081-831-1016)Pressure dressings aid in blood
clotting and compress the open blood vessel. If bleeding continues after the application
of a field dressing, manual pressure, and elevation, then a pressure dressing
must be applied as follows:a. Place a wad of padding on top of the
field dressing, directly over the wound (Figure 2-35). Keep injured extremity
elevated.

NOTEImprovised
bandages may be made from strips of cloth. These strips may be made from T-shirts,
socks, or other garments.

b.
Place an improvised dressing (or cravat, if available) over the wad of padding
(Figure 2-36). Wrap the ends tightly around the injured limb, covering the previously
placed field dressing (Figure 2-37).c.
Tie the ends together in a nonslip knot, directly over the wound site (Figure
2-38). DO NOT tie so tightly that it has a tourniquet-like effect. If bleeding
continues and all other measures have failed, or if the limb is severed, then
apply a tourniquet. Use the tourniquet as a LAST RESORT. When the bleeding
stops, check and treat for shock.

NOTEWounded
extremities should be checked periodically for adequate circulation. The dressing
must be loosened if the extremity becomes cool, blue or gray, or numb.

2-20.
Tourniquet (081-831-1017)A tourniquet is a constricting band placed
around an arm or leg to control bleeding. A soldier whose arm or leg has been
completely amputated may not be bleeding when first discovered, but a tourniquet
should be applied anyway. This absence of bleeding is due to the body’s normal
defenses (contraction of blood vessels) as a result of the amputation, but after
a period of time bleeding will start as the blood vessels relax. Bleeding from
a major artery of the thigh, lower leg, or arm and bleeding from multiple arteries
(which occurs in a traumatic amputation) may prove to be beyond control by manual
pressure. If the pressure dressing under firm hand pressure becomes soaked with
blood and the wound continues to bleed, apply a tourniquet.

WARNINGCasualty
should be continually monitored for development of conditions which may require
the performance of necessary basic lifesaving measures, such as: clearing the
airway, performing mouth-to-mouth resuscitation, preventing shock, and/or bleeding
control. All open (or penetrating) wounds should bechecked for a point of
entry or exit and treated accordingly.

*The
tourniquet should not be used unless a pressure dressing has failed to stop the
bleeding or an arm or leg has been cut off. On occasion, tourniquets have
injured blood vessels and nerves. If left in place too long, a tourniquet can
cause loss of an arm or leg. Once applied, it must stay in place, and the casualty
must be taken to the nearest medical treatment facility as soon as possible. DO
NOT loosen or release a tourniquet after it has been applied and the bleeding
has stopped.a. Improvising a Tourniquet (081-831-1017).In the
absence of a specially designed tourniquet, a tourniquet may be made from a strong,
pliable material, such as gauze or muslin bandages, clothing, or kerchiefs. An
improvised tourniquet is used with a rigid stick-like object. To minimize skin
damage, ensure that the improvised tourniquet is at least 2 inches wide.

WARNINGThe
tourniquet must be easily identified or easily seen.

WARNINGDO
NOT use wire or shoestring for a tourniquet band.

WARNINGA
tourniquet is only used on arm(s) or leg(s) where there is danger of loss of casualty’s
life.

b.
Placing the Improvised Tourniquet (081-831-1017).(1) Place the tourniquet
around the limb, between the wound and the body trunk (or between the wound and
the heart). Place the tourniquet 2 to 4 inches from the edge of the wound site
(Figure 2-39). Never place it directly over a wound or fracture or directly on
a joint (wrist, elbow, or knee). For wounds just below a joint, place the tourniquet
just above and as close to the joint as possible.(2)
The tourniquet should have padding underneath. If possible, place the tourniquet
over the smoothed sleeve or trouser leg to prevent the skin from being pinched
or twisted. If the tourniquet is long enough, wrap it around the limb several
times, keeping the material as flat as possible. Damaging the skin may deprive
the surgeon of skin required to cover an amputation. Protection of the skin also
reduces pain.c. Applying the Tourniquet (081-831-1017).(1) Tie
a half-knot. (A half-knot is the same as the first part of tying a shoe lace.)(2)
Place a stick (or similar rigid object) on top of the halfknot (Figure 2-40).(3)
Tie a full knot over the stick (Figure 2-41).(4)
Twist the stick (Figure 2-42) until the tourniquet is tight around the limb and/or
the bright red bleeding has stopped. In the case of amputation, dark oozing blood
may continue for a short time. This is the blood trapped in the area between the
wound and tourniquet.(5)
Fasten the tourniquet to the limb by looping the free ends of the tourniquet over
the ends of the stick. Then bring the ends around the limb to prevent the stick
from loosening. Tie them together under the limb (Figure 2-43A and B).NOTE
(081-831-1017)Other methods of securing the stick may be used as long
as the stick does not unwind and no further injury results.

NOTEIf
possible, save and transport any severed (amputated) limbs or body parts with
(but out of sight of) the casualty.

(6)
DO NOT cover the tourniquet–you should leave it in full view. If the limb is missing
(total amputation), apply a dressing to the stump.(7) Mark the casualty’s
forehead, if possible, with a “T” to indicate a tourniquet has been applied. If
necessary, use the casualty’s blood to make this mark.(8) Check and treat
for shock.(9) Seek medical aid.

CAUTION
(081-831-1017)DO NOT LOOSEN OR RELEASE THE TOURNIQUET ONCE IT HAS BEEN
APPLIED BECAUSE IT COULD ENHANCE THE PROBABILITY OF SHOCK.

Section
III. CHECK AND TREAT FOR SHOCK2-21. Causes and Effectsa. Shock
may be caused by severe or minor trauma to the body. It usually is the result
of— Significant loss of blood. Heart failure. Dehydration.
Severe and painful blows to the body. Severe burns of the body.
Severe wound infections. Severe allergic reactions to drugs, foods,
insect stings, and snakebites.b. Shock stuns and weakens the body.
When the normal blood flow in the body is upset, death can result. Early identification
and proper treatment may save the casualty’s life.c. See FM 8-230 for
further information and details on specific types of shock and treatment.

2-22.
Signs/Symptoms (081-831-1000)Examine the casualty to see if he
has any of the following signs/symptoms: Sweaty but cool skin (clammy
skin). Paleness of skin. Restlessness, nervousness.
Thirst. Loss of blood (bleeding). Confusion (or loss of awareness).
Faster-than-normal breathing rate. Blotchy or bluish skin (especially
around the mouth and lips). Nausea and/or vomiting.

2-23.
Treatment/Prevention (081-831-1005)In the field, the procedures
to treat shock are identical to procedures that would be performed to prevent
shock. When treating a casualty, assume that shock is present or will occur shortly.
By waiting until actual signs/symptoms of shock are noticeable, the rescuer may
jeopardize the casualty’s life.a. Position the Casualty. (DO NOT move
the casualty or his limbs if suspected fractures have not been splinted. See Chapter
4 for details.)(1) Move the casualty to cover, if cover is available and the
situation permits.(2) Lay the casualty on his back.

NOTEA
casualty in shock after suffering a heart attack, chest wound, or breathing difficulty,
may breathe easier in a sitting position. If this is the case, allow him to sit
upright, but monitor carefully in case his condition worsens.

(3)
Elevate the casualty’s feet higher than the level of his heart. Use a stable object
(a box, field pack, or rolled up clothing) so that his feet will not slip off
(Figure 2-44).

WARNINGDO
NOT elevate legs if the casualty has an unsplinted broken leg, head injury, or
abdominal injury. (See task 081-831-1034, Splint a Suspected Fracture,
and task 081-831-1025, Apply a Dressing to an Open Abdominal Wound.)

WARNING
(081-831-1005)Check casualty for leg fracture(s) and splint, if necessary,
before elevating his feet. For a casualty with an abdominal wound, place knees
in an upright (flexed) position.

(4)
Loosen clothing at the neck, waist, or wherever it may be binding.

CAUTION
(081-831-1005)DO NOT LOOSEN OR REMOVE protective clothing in a chemical
environment.

(5)
Prevent chilling or overheating. The key is to maintain body temperature. In cold
weather, place a blanket or other like item over him to keep him warm and under
him to prevent chilling (Figure 2-45). However, if a tourniquet has been applied,
leave it exposed (if possible). In hot weather, place the casualty in the shade
and avoid excessive covering. (6)
Calm the casualty. Throughout the entire procedure of treating and caring for
a casualty, the rescuer should reassure the casualty and keep him calm. This can
be done by being authoritative (taking charge) and by showing self-confidence.
Assure the casualty that you are there to help him.(7) Seek medical aid.b.
Food and/or Drink. During the treatment/prevention of shock, DO NOT give the
casualty any food or drink. If you must leave the casualty or if he is unconscious,
turn his head to the side to prevent him from choking should he vomit (Figure
2-46).